Outcomes following myxopapillary ependymoma resection

The importance of capsule integrity

Mohammed Abdulaziz, Grant W. Mallory, Mohamad Bydon, Rafael De la Garza Ramos, Jason A. Ellis, Nadia N Laack, W. Richard Marsh, William E. Krauss, George Jallo, Ziya L. Gokaslan, Michelle J. Clarke

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Object While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. Methods A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. Results Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7-68 years). The median follow-up was 51.5 months (range 12-243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. Conclusions A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.

Original languageEnglish (US)
Pages (from-to)E8
JournalNeurosurgical Focus
Volume39
Issue number2
DOIs
StatePublished - 2015

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Ependymoma
Capsules
Adjuvant Radiotherapy
Recurrence
Disease-Free Survival
Salvage Therapy
Neoplasms
Disease Progression
Radiation

Keywords

  • Capsule
  • Myxopapillary ependymoma
  • Radiation therapy
  • Surgery
  • Tumor recurrence

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Abdulaziz, M., Mallory, G. W., Bydon, M., Ramos, R. D. L. G., Ellis, J. A., Laack, N. N., ... Clarke, M. J. (2015). Outcomes following myxopapillary ependymoma resection: The importance of capsule integrity. Neurosurgical Focus, 39(2), E8. https://doi.org/10.3171/2015.5.FOCUS15164

Outcomes following myxopapillary ependymoma resection : The importance of capsule integrity. / Abdulaziz, Mohammed; Mallory, Grant W.; Bydon, Mohamad; Ramos, Rafael De la Garza; Ellis, Jason A.; Laack, Nadia N; Marsh, W. Richard; Krauss, William E.; Jallo, George; Gokaslan, Ziya L.; Clarke, Michelle J.

In: Neurosurgical Focus, Vol. 39, No. 2, 2015, p. E8.

Research output: Contribution to journalArticle

Abdulaziz, M, Mallory, GW, Bydon, M, Ramos, RDLG, Ellis, JA, Laack, NN, Marsh, WR, Krauss, WE, Jallo, G, Gokaslan, ZL & Clarke, MJ 2015, 'Outcomes following myxopapillary ependymoma resection: The importance of capsule integrity', Neurosurgical Focus, vol. 39, no. 2, pp. E8. https://doi.org/10.3171/2015.5.FOCUS15164
Abdulaziz, Mohammed ; Mallory, Grant W. ; Bydon, Mohamad ; Ramos, Rafael De la Garza ; Ellis, Jason A. ; Laack, Nadia N ; Marsh, W. Richard ; Krauss, William E. ; Jallo, George ; Gokaslan, Ziya L. ; Clarke, Michelle J. / Outcomes following myxopapillary ependymoma resection : The importance of capsule integrity. In: Neurosurgical Focus. 2015 ; Vol. 39, No. 2. pp. E8.
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title = "Outcomes following myxopapillary ependymoma resection: The importance of capsule integrity",
abstract = "Object While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. Methods A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. Results Of the 107 patients reviewed, 58 patients (53{\%} were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7-68 years). The median follow-up was 51.5 months (range 12-243 months). Extent of resection was defined as en bloc in 46.5{\%} (n = 27), GTR in 34.5{\%} (n = 20), and STR in 18.9{\%} (n = 11). No recurrences were noted in the en bloc group, compared with 15{\%} (n = 3) and 45{\%} (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20{\%}) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8{\%} (n = 8), and the 5-year PFS was 81{\%}. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7{\%} vs 31.6{\%}, p = 0.43) and longer PFS at 5 years (83.3{\%} vs 49.9{\%}, p = 0.16) in cases of capsular violation. Conclusions A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.",
keywords = "Capsule, Myxopapillary ependymoma, Radiation therapy, Surgery, Tumor recurrence",
author = "Mohammed Abdulaziz and Mallory, {Grant W.} and Mohamad Bydon and Ramos, {Rafael De la Garza} and Ellis, {Jason A.} and Laack, {Nadia N} and Marsh, {W. Richard} and Krauss, {William E.} and George Jallo and Gokaslan, {Ziya L.} and Clarke, {Michelle J.}",
year = "2015",
doi = "10.3171/2015.5.FOCUS15164",
language = "English (US)",
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TY - JOUR

T1 - Outcomes following myxopapillary ependymoma resection

T2 - The importance of capsule integrity

AU - Abdulaziz, Mohammed

AU - Mallory, Grant W.

AU - Bydon, Mohamad

AU - Ramos, Rafael De la Garza

AU - Ellis, Jason A.

AU - Laack, Nadia N

AU - Marsh, W. Richard

AU - Krauss, William E.

AU - Jallo, George

AU - Gokaslan, Ziya L.

AU - Clarke, Michelle J.

PY - 2015

Y1 - 2015

N2 - Object While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. Methods A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. Results Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7-68 years). The median follow-up was 51.5 months (range 12-243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. Conclusions A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.

AB - Object While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. Methods A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. Results Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7-68 years). The median follow-up was 51.5 months (range 12-243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. Conclusions A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.

KW - Capsule

KW - Myxopapillary ependymoma

KW - Radiation therapy

KW - Surgery

KW - Tumor recurrence

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